The Trouble With Systematic Reviews Of Medicine

Doctors are obligated to stay informed of the latest developments in their field. But that’s not always easy: every year, over 300,000 medical journal articles are published in the United States. For example, last year, there were over 50,000 medical journal articles that related to heart disease, and over 40,000 that related to diabetes.

So what do doctors do? Often, they turn to “meta-analyses” and “systematic reviews.” These are supposed to be thoughtful collections and reviews of the medical literature, a cheat sheet for doctors to use to see the whole body of scientific literature at once. The systematic reviews seem like such a good idea — not just a cheat sheet, but a cheat sheet carefully reviewed by other doctors — but in practice they just didn’t turn out that way.

Even worse, many of these “objective” reviews are compromised by the authors’ financial ties to pharmaceutcial companies. As the author of the study told NPR, a whopping 80% of reviews of antidepressants were either paid for by the drug companies or were written by doctors and medical researchers with a financial interest in the manufacturer of the drugs.

In August 2016, the FDA narrowed the circumstances under which Levaquin and Cipro can be used, but many meta-analyses and reviews haven’t caught up with the changes. Even the reviews that have been updated don’t say a work about the connection between those antibiotics and aortic dissection, despite multiple studies showing a link, and so many doctors continue to prescribe those antibiotics even to patients who have aortic aneurysms, putting the patients in grave harm.

Botox injections are often used as a treatment for cerebral palsy. Botox often provides relief from spasticity in the muscle for several weeks, but after that it begins to fade, and the patients often come back for another injection. Unfortunately, many medical reviews mention that use without pointing out that Botox cannot be used more than once every three months, and that the risk of infection from this use is unknown. Even worse, many reviews don’t spell out how doctors are to tell the difference between reduced spasticity and muscle weakness, which can be a sign of an infection spread.

All in all, there’s a lot of work to be done in the medical profession to clean up the ways doctors get medical information. In many circumstances, a doctor would be better off Googling for an answer than they would be relying on an expensive “systematic review” that was actually funded by a drug company.

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I’m a trial lawyer for people who have been seriously hurt. I’m listed in Super Lawyers and Best Lawyers in America and I have an “Excellent” rating from Avvo. I have a B.A. in History with Honors from Yale University and a J.D. from the Beasley School of Law at Temple University. For the past ten years, my law practice has been devoted to representing injured plaintiffs. Read More